, , 2007

4 Nov 2008 00:00:00 UTC-0700

Physical Address:
826 A Sreet
Springfield, OR 97477
[VIEW MAP]

Office Hours:
Tuesday and Thursday
9am to noon

Mailing Address:
P.O. Box 11138
Eugene, OR 97440-3338

Phone: 541-484-5099
Fax: 541-762-1081
Email: webeditor@dplc.org

Become a Card-Carrying Contributor to the DPLC

STEP 1 OF 2 - MEMBERSHIP FORM

For only $20 a year, you can be a part of something big: change! You can be a part of something local and progressive. Becoming a card-carrying contributor to the DPLC means you support Democratic principles.

Card-carrying contributors get advance notice of all DPLC sponsored events; invitations to VIP gatherings; regular updates about important activities; and, most importantly, the satisfaction that comes from supporting Democratic principles.

Please complete all required information on the form below, press the submit button, and then pay with any credit card or your PayPal account at PayPal.com. We use PayPal because they are secure and cost-effective. If possible, use the same name that appears on the credit card or PayPal account you will use.

*Required information

First Name	*
Last Name	*
Address	*
City	*
State	*
Zip	*
Phone	*
Cell Phone
E-mail	*
The following information is required for political contributions:
Occupation (see note below)	*
Employer's Name	*
Employer's Location (City/State)	*
Check this box to confirm that the following statements are true and accurate: 1. I am a United States citizen or a permanent resident alien. 2. I am at least 18 years old. 3. This contribution is not made from the general treasury funds of a corporation, labor organization or national bank. 4. This contribution is not made from the treasury of an entity or person who is a federal contractor. 5. The funds I am donating are not being provided to me by another person or entity for the purpose of making this contribution. * NOTE: Please be as specific as possible with occupation. For example School Administrator instead of just Administrator or Printing Business Owner instead of just Owner. Your contribution is not tax-deductible as a charitable contribution for Federal income tax purposes. Federal Election law requires political committees to report the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of $200 in a calendar year. Your contribution will be used in connection with Federal elections and is subject to the limits and prohibitions of the Federal Election Campaign Act.